Transcatheter Aortic Valve Replacement (TAVR): Everything You Need to Know

Minimally invasive treatment for aortic stenosis

Transcatheter aortic valve replacement (TAVR)—also referred to as transcatheter aortic valve implantation (TAVI)—is a minimally invasive heart surgery in which a malfunctioning aortic valve is replaced with an artificial one. This procedure is a less invasive alternative to the traditional open-heart surgery method of replacing a heart valve.

TAVR is often favored for patients at high risk of surgical complications because of this, although it is still a major surgery that can have complications. TAVR is also being considered more and more for people who don't have such pre-operative concerns.

What Is TAVR?

A transcatheter procedure is a type of surgery that relies on a small incision in the skin to thread a catheter (small tube) through a blood vessel to reach the surgical destination. An aortic valve replacement involves the implantation of an expandable artificial valve made of metal and animal tissue into the heart.

If you have a TAVR, your artificial aortic valve would be inserted into its position after your surgeon advances it through a catheter to the aorta.

The aorta, which emerges directly from the heart, is the largest artery you have. Its branches carry oxygenated blood from the heart to the rest of your body. The aortic valve—composed of several cusps of tissue—is located between the heart and the aorta, and it helps control blood flow between the two.

An interventional cardiologist or a heart surgeon would perform your TAVC. Your incision will either be in your groin (under monitored anesthesia sedation and local anesthesia) or in your chest (under general anesthesia).

Contraindications

You might not be a candidate for TAVR if your health is very unstable or if you have mild aortic valve disease.

You can have a high risk of surgical complications or death from this procedure if you have organ failure (such as kidney failure or pulmonary failure). This could make TAVR more risky than beneficial for you.

Additionally, if you have a life expectancy of less than a year (e.g., you have end-stage cancer), this surgery could increase your risk of death.

Your health insurance payer might not approve this minimally invasive method of valve replacement if you have mild aortic disease or a low risk of surgical complications. The guidelines regarding the indications for selecting this procedure instead of an open aortic valve replacement are changing.

Potential Risks

The risks of general anesthesia and any surgical procedure apply to TAVR. This surgery also poses a risk of some additional concerns.

Possible complications of transcatheter aortic valve replacement include:

  • Postoperative stroke
  • Heart attack
  • Blood clots
  • Bleeding at the incision site
  • An infection at the incision site
  • An injury to the heart during the procedure
  • Arrhythmia (irregular heart rhythm)
  • Endocarditis (infection of the valve)

Complications after heart surgery can be serious and may be life-threatening. You will be closely monitored in the hospital for the first day after your operation so your doctors can identify signs of problems at an early stage.

Purpose of TAVR

A TAVR is done to replace—not repair—a damaged aortic heart valve.

When the aortic valve is damaged due to calcification, its cusps do not move the way they should. This can cause aortic regurgitation (when blood leaks as it travels through the aorta) and/or aortic stenosis (narrowing of the aorta).

Aortic valve disease is common and typically develops with age. It can cause fatigue, exercise intolerance, syncope (episodes of fainting), chest pain, and congestive heart failure. The condition can become so severe that it is life-threatening if left untreated.

Replacement of the aortic valve can alleviate symptoms of aortic valve disease and may prolong life.

Your doctor may consider TAVR as an option for an aortic valve replacement without the physical stress of open-heart surgery and cardiopulmonary bypass. A transcatheter procedure typically allows for a faster recover and carries the same risk of surgical complications.

How to Prepare

Before having a TAVR, you will have an assessment of your aortic valve. Your surgeon will likely observe the function of your heart and the structure and motion of your aortic valve with an echocardiogram. Measurements of the valve and the aorta will be taken in preparation for your surgery.

Additionally, you will have an ultrasound test to assess the size and patency (extent of opening) of blood vessels that will be accessed during your surgery.

Your pre-operative testing will include a complete blood count (CBC), blood chemistry tests, a chest X-ray, and an electrocardiogram (EKG).

Location

You will go to your surgery from home, and you will spend at least one night in the hospital after your operation. Your procedure will be done in a hospital operating room or procedural suite.

What to Wear

You can wear anything comfortable to your surgery appointment. You will have to wear a hospital gown during a TAVR.

Food and Drink

If you are having general anesthesia, you need to fast from food and drink after midnight the night before your surgery.

If you are having monitored anesthesia sedation, you will not have to adjust your food and drink in preparation for your surgery.

Medications

Your doctor will instruct you about whether you should adjust the dose of any blood thinners or medications that you take for treating heart disease.

Be sure your doctor is aware of any and all medications and supplements you take, be them prescription, over-the-counter, herbal, or recreational.

What to Bring

When you go to your surgery appointment, you need to bring your identification and insurance information. If you will be paying for a portion of your surgery, you should bring a form of payment.

Pack whatever you need for your hospital stay, such as a change of clothes, toiletries, etc. Leave valuables at home.

You should have someone who can drive you home when you are discharged from the hospital.

Pre-Op Lifestyle Changes

Smoking can interfere with recovery, so your doctor may talk to you about smoking cessation prior to your surgery.

What to Expect on the Day of Surgery

When you go for your surgery, you will have to register and sign a consent form. A staff member will then escort you to a pre-operative area where you will change into a hospital gown.

You may have same-day tests, including CBC, blood chemistry, and urinalysis. You may have a urinary catheter placed before you go to the operating room or after you get there.

An intravenous (IV, in a vein) line placed in your hand or arm. You will have your temperature, blood pressure, pulse, respiratory rate, and oxygen saturation checked.

Before the Surgery

Once in the operating room, your body will be covered with a surgical drape, and the area of skin where you will have your incision will be exposed and cleansed. Your anesthesia will be started as the medication is injected into your IV.

For general anesthesia, the medication will put you to sleep and you will have a breathing tube placed in your throat for breathing assistance during surgery. For monitored anesthesia sedation, you will have anesthetic medication injected in your IV to make you drowsy, and local anesthesia will be placed in the skin near the incision site.

During the Surgery

Your surgeon will begin your surgery by making a small incision (less than an inch in length). Your incision may be placed in your groin to access your femoral artery or in between your ribs to access your subclavian artery.

The catheter is placed into the artery through the skin incision. With imaging guidance, the catheter and the replacement valve are advanced through the blood vessels until they reach the aortic valve.

The artificial valve is bundled into a tiny package that is small enough to be moved through the blood vessel along with the catheter. When in place, the valve replacement is deployed, allowing it to open to its full size. 

Usually, the replacement valve is placed over the original diseased aortic valve so it can take over the function of controlling the release of blood from the heart.

The diseased valve is not typically removed, although atherosclerotic plaque may be resected from the valve tissue. If you've had an artificial valve placed in the past, and it is now malfunctioning, it will be removed and replaced.

After the replacement valve is properly positioned, your surgeon will observe its function using imaging studies. If the placement is correct and the valve is functioning properly, the catheter will be removed. If any adjustment is needed, that will be done before the catheter is removed.

The blood vessel and skin incision will each be closed with suture, and your skin will be covered with a surgical dressing.

Anesthesia is stopped or reversed. And if you have had a breathing tube during your surgery, it will be removed and your anesthesia team will ensure that you are breathing comfortably on your own.

After the Surgery

In the recovery area, you will begin to wake up. You may feel a little groggy. The medical team in the recovery area will help you walk and give you medication for pain as needed.

During your hospital stay, your heart function will be monitored with an EKG, and your oxygen saturation will be monitored with pulse oximetry. Your blood pressure, pulse, and respiratory rate will be monitored as well.

Your surgical wound will be checked and your medical team will explain how you should take care of it at home.

You may have some of your heart medications, like your blood pressure medication, adjusted. And you will be getting blood thinner medication while you're in the hospital, as well as a prescription for blood thinner medication to prevent blood clots. You may also get a prescription for pain medication to take at home.

After one day or a few days, you will be discharged.

Recovery

You should feel comfortable as you are recovering after your valve replacement. You may begin to feel more energetic than you did prior to your surgery within days of your procedure.

However, you should take it easy as your wound heals and until your doctor evaluates your heart function. Avoid driving or physically demanding activities like heavy lifting, pushing, or pulling. While your valve repair will certainly alleviate some of your heart function issues, you might still have limitations due to another remaining heart concern.

During follow-up appointments with your doctor, your wound will be examined, sutures removed, and your heart function evaluated.

Because a TAVR involves a small incision, it should heal within about a week. If you have developed heart disease (e.g., heart failure) prior to having your valve replacement, your doctor may recommend that you begin cardiac rehabilitation.

Healing

In your first few days home after your surgery, you might have mild to moderate pain at your incision site. You can take pain medication as directed. You will need to get up and walk around to avoid complications like blood clots. Your doctor may even prescribe a target number of steps for you to take.

You will need to keep your wound clean and dry as it is healing. You can and should shower (pat your wound to dry your skin), but you should avoid taking baths, swimming, and going in hot tubs until the skin is fully healed. Don't use creams, lotions, or powders on the surgical area. Replace your bandage as directed by your doctor.

If you have mild swelling, you can use an ice pack to reduce the swelling. Don't place the ice pack directly on your skin.

Signs of complications to look out for include:

  • Worsening pain at your incision site
  • Fever
  • Bleeding, pus, warmth, redness, or severe swelling near the incision
  • Growing or hard lump at your incision site
  • Numbness of your leg (or your arm if you had the incision in your chest)
  • Chest pain
  • Shortness of breath
  • Dizziness
  • Fainting
  • Palpitations (a sense that you have a rapid or irregular heart rate)

Call your doctor's office if you start to experience any of these issues.

Coping With Recovery

As you are recovering, you may need to adjust to taking new medications. Blood thinners can make you prone to bleeding, so you have to be careful about avoiding injury.

You may also be taking new medications or different doses of your previous medications for the treatment of heart failure or hypertension. Be sure to stay in touch with your doctor if you experience any side effects of these treatments, such as lightheadedness, shortness of breath, fatigue, or palpitations.

Some people have a decreased appetite after TAVR, especially if low appetite was a problem prior to the surgery. Research suggests that nutritional deficits can interfere with a healthy recovery. Talk to your doctor about your dietary intake so you can receive treatment with dietary supplements if you need them.

Long-Term Care

After TAVR, you will still need to take steps for a healthier heart if you have other issues like atherosclerosis, hypertension, heart failure, or arrhythmia. Having a heart valve replacement can have a major positive impact on your health, but it doesn't address all heart problems. Heart disease is usually managed with a combination of medication and lifestyle adjustments.

You will need to remain on blood thinner medication as directed by your doctor for as long as you have your valve in place.

You will also need periodic monitoring of your heart function, which can include an EKG and an echocardiogram.

Reducing Risk of Endocarditis

After a heart valve replacement, you can be at risk of developing endocarditis after dental work. You should tell your dentist about your artificial heart valve, as you may need to take antibiotics before having dental work to prevent an infection. Also consider carrying a card provided by the American Heart Association that specifically describes your risk, should the information need to be referenced in a healthcare setting.

Possible Future Surgeries

Although a valve can last for your whole lifetime, this is not always the case. Depending on the valve that you have, you may need a replacement after 10 or 15 years.

If your valve begins to lose optimal function, you may develop symptoms of aortic valve disease. You and your doctor will have to discuss whether another surgery is advisable if your valve starts to fail.

Many times, the same risk factors that led to aortic valve disease can lead to other heart problems, such as coronary artery disease or cardiac arrythmia. This may require you to have another type of heart surgery after your TAVR. 

Lifestyle Adjustments

Overall, you should feel better after your TAVR than you did before the surgery. The most important adjustment you have to consider is the risk of bleeding due to blood thinners. You may have already been taking blood thinners for years prior to your TAVR surgery, so this may not necessarily be a change for you.

The risk of bleeding means that you need to avoid activities that could cause major falls, such as hiking or climbing on an irregular surface. And you may even need to be extra careful when biking or walking up and down the stairs, especially if you don't have a good balance.

Staying active, maintaining a low cholesterol diet, and avoiding smoking are vital steps to preventing future heart issues like aortic valve disease.

A Word From Verywell

Having a minimally invasive aortic valve replacement can improve symptoms of aortic valve disease and can prevent death due to this disease. The surgery would give you a faster recovery time than open-heart valve replacement. But because a TAVR is a type of heart surgery, advance surgical planning is a major part of the process and there is a risk of surgical and post-surgical complications that you need to consider when thinking about having this operation.

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